Ppt chapter048

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Ppt chapter048

  1. 1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction to Clinical Pharmacology Chapter 48- Diuretics
  2. 2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Diuretics: Actions • Carbonic anhydrase inhibitors: – Inhibits the enzyme carbonic anhydrase – Results in excretion of sodium, potassium, bicarbonate, and water – Used to treat glaucoma – Decreases the production of aqueous humor in the eye, which in turn decreases intraocular pressure
  3. 3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Diuretics: Actions (cont’d) • Loop diuretics: – Increases the excretion of sodium and chloride – Torsemide: Acts primarily in the ascending portion of the loop of Henle – Bumetanide: Acts primarily on the proximal tubule of the nephron
  4. 4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Diuretics: Actions (cont’d) • Potassium-sparing diuretics: – Triamterene, amiloride: Depresses the reabsorption of sodium in the kidney tubules – Spironolactone: Antagonizes the action of aldosterone – Aldosterone: Enhances the reabsorption of sodium in the distal convoluted tubules of the kidney
  5. 5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Diuretics: Actions (cont’d) • Thiazides and related diuretics: – Inhibits reabsorption of sodium and chloride ions in the ascending portion of the loop of Henle and early distal tubule of nephron • Osmotic diuretics: – Increases the density of the filtrate in the glomerulus
  6. 6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Diuretics: Uses • Used in the treatment of: – Edema associated with congestive heart failure – Hypertension – Renal disease – Cerebral edema – Acute glaucoma and increased IOP – Short-term management of ascites
  7. 7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Diuretics: Adverse Reactions • Neuromuscular reactions: Dizziness, lightheadedness, headache, weakness, fatigue • Cardiovascular reactions: Orthostatic hypotension, electrolyte imbalances, glycosuria • Gastrointestinal (GI) reactions: Anorexia, nausea, vomiting • Other reactions: Hypokalemia, hyperkalemia, gynecomastia
  8. 8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Diuretics: Contraindications • Contraindicated in patients: – With known hypersensitivity to the drugs, electrolyte imbalances, severe kidney or liver dysfunction, and anuria • Mannitol: Contraindicated in patients with active intracranial bleeding • Potassium-sparing diuretics: Contraindicated in patients with hyperkalemia; Not recommended for children
  9. 9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Diuretics: Precautions • Used cautiously in patients: With renal dysfunction; During pregnancy, lactation • Thiazide and loop diuretics: – Used cautiously in patients with liver disease, diabetes, lupus erythematosus, or diarrhea • Potassium-sparing diuretics: – Used cautiously in patients with liver disease, diabetes, or gout
  10. 10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Diuretics: Interactions Interactant Drug Effect of Interaction Primidone Decreased effectiveness of primidone • Carbonic Anhydrase Inhibitors
  11. 11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Diuretics: Interactions (cont’d) • Loop diuretics Interactant Drug Effect of Interaction Digitalis Increased risk of arrhythmias Cisplatin, aminoglycosides Increased risk of ototoxicity Anticoagulants or thrombolytics Increased risk of bleeding Lithium Increased risk for lithium toxicity Hydantoins (phenytoin) Decreased diuretic effectiveness NSAIDs and salicylates Decreased diuretic effectiveness
  12. 12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Diuretics: Interactions (cont’d) • Potassium-Sparing diuretics Interactant Drug Effect of Interaction Angiotensin-converting enzyme (ACE) inhibitors or potassium supplements Increased risk for hyperkalemia Nonsteroidal anti- inflammatory drugs (NSAIDs), salicylates and anticoagulants Decreased diuretic effectiveness
  13. 13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Diuretics: Interactions (cont’d) • Thiazides and Related diuretics Interactant Drug Effect of Interaction Allopurinol Increased risk for hypersensitivity to allopurinol Anesthetics Increased anesthetic effectiveness Antineoplastic drugs Extended leukopenia Antidiabetic drugs Hyperglycemia
  14. 14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment • Preadministration assessment: – Take vital signs and weigh the patient – Review laboratory results – If patient has peripheral edema: Inspect the involved areas and record in the patient’s chart the degree, extent of edema, – Review the patient’s chart for a description of the seizures and their frequency
  15. 15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment • Ongoing assessment: – Measure and record fluid intake and output – Report to the primary health care provider any marked decrease in the fluid output – Weigh the patient daily
  16. 16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Planning • Expected outcomes: – Optimal response to drug therapy – Management of patient needs related to adverse drug reactions – Correction of a fluid volume deficit – Absence of injury – Understanding of and compliance with the postdischarge drug regimen
  17. 17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy – Patient with edema: •Weigh the patient; Measure and record the fluid intake and output •Assess the blood pressure, pulse, respiratory rate •Examine areas of edema daily and record findings in the patient’s chart
  18. 18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d) – Patient with hypertension: •Monitor blood pressure, pulse, respiratory rate before administration of the drug
  19. 19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d) – Patient with acute glaucoma: •Evaluate the patient’s response to drug therapy every 2 hours •Assist the patient with ambulatory and self-care activities
  20. 20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d) – Patient with seizure activity: •Assess the patient at frequent intervals for the occurrence of seizures •Record a description of the seizure in the patient’s chart, including time of onset and duration
  21. 21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d) – Patient with increased intracranial pressure •Monitor the urine output, blood pressure, pulse, and respiratory rate •Perform neurologic assessments at time intervals •Monitor for signs and symptoms indicating decrease in intracranial pressure
  22. 22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d) – Patient with renal compromise: •Monitor renal function periodically •Monitor serum uric acid concentrations and serum glucose concentration periodically •Monitor for any joint pain or discomfort
  23. 23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d) – Patient at risk for hypokalemia: •Monitor serum potassium levels frequently •Treatment for hyperkalemia: administration of IV bicarbonate or oral or parenteral glucose with rapid-acting insulin
  24. 24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Monitoring and managing patient needs – Impaired urinary elimination: •Explain the purpose and effects of the drug to reduce anxiety •Administer the drug early in the day •Make sure that patient on bed rest has a call light and, a bedpan or urinal within easy reaches
  25. 25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Monitoring and managing patient needs (cont’d) – Risk for deficient fluid volume: •Encourage patients to eat and drink all food and fluids served at mealtime •Monitor fluid intake and output •Assess for signs and symptoms of electrolyte imbalance
  26. 26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Monitoring and managing patient needs – Risk for injury: •Frequently monitor pulse rate and rhythm •Assist the patients who are dizzy, but allowed out of bed, with ambulatory activities
  27. 27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Educating the patient and family – Explain the importance of taking the drug at prescribed time intervals and as directed – Advise about the importance of completing the entire course of treatment – Emphasize the importance of taking the drug with food or milk
  28. 28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Educating the patient and family (cont’d) – Do not reduce fluid intake to reduce the need to urinate – Instruct patient to avoid alcohol, nonprescription drugs – Emphasize observing caution while driving or performing hazardous tasks – Explain necessary interventions if dizziness or weakness occurs
  29. 29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Educating the patient and family (cont’d) – Explain the importance of avoiding exposure to sunlight or ultraviolet light – Explain to patients with diabetes mellitus and who take loop or thiazide diuretics to contact health care provider if increase in blood glucose level
  30. 30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Educating the patient and family (cont’d) – For patients taking potassium-sparing diuretics: Emphasize the importance of avoiding foods high in potassium and use of salt substitutes containing potassium – For patients taking thiazide diuretics: Explain the necessity of contacting the primary health care provider if sudden joint pain occurs
  31. 31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Educating the patient and family (cont’d) – For patients taking carbonic anhydrase inhibitors: Explain the necessity of contacting the primary health care provider immediately if eye pain is not relieved or increased
  32. 32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Evaluation • Therapeutic effect is achieved • Adverse reactions are identified, reported, and managed successfully • Fluid volume problems are corrected • No injury is evident
  33. 33. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Evaluation (cont’d) • Patient verbalizes the importance of complying with the prescribed treatment regimen • Patient and family demonstrate an understanding of the drug regimen
  34. 34. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation

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